Implant indications

Without a doubt, osseointegration is the therapy of choice for replacing missing teeth in elderly patients. But how should an adolescent patient with anterior tooth avulsion caused by trauma be treated? In these types of cases, autotransplantation may be a useful and more reliable treatment option than implants or removable dentures.

“Osseointegration is the therapy of choice for replacing missing teeth in elderly patients”

Transplantation involves grafting a tooth from one place to another. The method has been widely used throughout the history of dental treatment. The first modern documented report of autotransplantation was published in 1992 by Jens Andreasen (Andreasen et al. 1992).

The most common indication for the procedure is replacing a non-restorable or missing first molar with an immature third molar. The second indication is transplanting premolars when anterior teeth have been lost by trauma in young patients.

When performing autotransplantation, it is crucial to avoid injuring the periodontal ligament. To this end, the immature transplanted tooth should be handled with extreme care and placed without compression in an enlarged neo-alveolus, with extra space measuring 2mm apically and 0.5–1mm all around, and should be stabilised infra-occlusally by sutures in a non-rigid way.

“When performing autotransplantation, it is crucial to avoid injuring the periodontal ligament”

The speaker outlined a proposed approach which they published in 2016 for autotransplantation using pre-planned 3D surgical guides with a fully digital workflow similar to treatments with implants (Strbac et al. 2016). The procedure is as follows: both the tooth to be extracted and the tooth to be transplanted are segmented in the 3D computer reconstruction and a virtual transplantation is made. Next, the oral scan is merged with CBCT data and a surgical template is designed and produced by 3D printing. The extraction in the recipient site is performed using a piezoelectric device to preserve the tissues as much as possible. The site is then drilled precisely through the guides for each root, and a template (with the shape of the donor tooth included) is checked to make sure the preparation is correct. Finally, the donor tooth is removed atraumatically using the piezoelectric device and immediately transplanted into the prepared site. The technique therefore draws on both surgical and guided prosthodontic procedures.

The advantages of autotransplantation are patented in cases involving children or adolescent patients, when it is indisputably the best treatment option. By using immature teeth, vitality is maintained and endodontics can be avoided, and the transplanted teeth can even be moved by orthodontics. The periodontal parameters, mobility tests and papilla indices for autotransplanted teeth are similar to natural contralateral teeth.

“The reported success rate of autotransplantation varies from 74% to 100%”

The reported success rate of autotransplantation varies from 74% to 100%. The retrospective five-year results of the speaker’s cohort study from the University of Vienna is 89.39% (Strbac et al. 2017). By using common techniques, the speaker reported that we can conclude that the success rate of autotransplanted teeth is about 90% at 5 years and 80% at 10 years.

Ankylosis and periapical lesions are a sign of autotransplantation failures and they may be strongly related to iatrogenic damage to the periodontium or press-fit compressions during intervention. For that reason, the speaker highly recommended the guided autotransplantation of teeth technique which he had previously described for treatment procedures. This technique can ensure higher success rates and reduce the risk of complications in the near future.

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